Skin, Hair, and Nails

Centimeter ruler (flexible, clear)


image Flashlight with transilluminator

image Wood’s lamp (to view fluorescing lesions)

image Handheld magnifying lens (optional)



EXAMINATION




image image


Cutaneous Color Changes

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TECHNIQUE FINDINGS
  Pigmented nevi. Nonpigmented striae. Freckles. Birthmarks.
UNEXPECTED:Dysplastic, precancerous, or cancerous nevi. Chloasma. Unpigmented skin. Generalized or localized color changes. Vascular skin lesions. Vascular changes.
imageThickness EXPECTED:Thickness variations, with eyelids thinnest, areas of rubbing thickest. Calluses on hands and feet.
UNEXPECTED:Atrophy. Hyperkeratosis. Corns.
imageSymmetry EXPECTED:Bilateral symmetry.
imageHygiene EXPECTED:Clean.
Palpate skin  
imageMoisture EXPECTED:Minimal perspiration or oiliness. Increased perspiration (associated with activity, environment, obesity, anxiety, excitement) noticeable on palms, scalp, forehead, axillae.
UNEXPECTED:Damp intertriginous areas.

image Temperature

Palpate with dorsal surface of hand or fingers.

EXPECTED:Cool to warm. Bilateral symmetry.
imageTexture EXPECTED:Smooth, soft, and even. Roughness resulting from heavy clothing, cold weather, or soap.
UNEXPECTED:Extensive or widespread roughness.
imageTurgor and mobility EXPECTED:Resilience.
Gently pinch skin on forearm or in sternal area, and release. UNEXPECTED:Failure of skin to return to place quickly.
image  
Inspect and palpate lesions  

image Size

Measure all dimensions.


image Shape

image Color

Use Wood’s lamp to distinguish fluorescing lesions.


image Blanching

image Texture

Transilluminate to determine presence of fluid.


image Elevation/depression

image Pedunculation

image Exudate

Note color, odor, amount, and consistency of lesion.


image Configuration

Check lesion for annular, grouped, linear, arciform, or diffuse arrangement.


image Location/distribution

Check lesion for generalized/localized, body region, patterns, or discrete/confluent.

UNEXPECTED:See table on pp. 3639

Primary Skin Lesions














































Description Examples
Macule  
Flat, circumscribed area that is a change in skin color; less than 1 cm in diameter Freckles, flat moles (nevi), petechiae, measles, scarlet fever


Measles. From Habif, 2004.

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Papule  
Elevated, firm, circumscribed area less than 1 cm in diameter Wart (verruca), elevated moles, lichen planus


Lichen planus. From Weston et al, 1996.

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Patch  
Flat, nonpalpable, irregular-shaped macule more than 1 cm in diameter Vitiligo, port-wine stains, mongolian spots, café au lait spots


Vitiligo. From Weston et al, 1991.

image image
Plaque  
Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter Psoriasis, seborrheic and actinic keratoses


Plaque. From Habif, 2004.

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Wheal  
Elevated irregular-shaped area of cutaneous edema; solid, transient; variable diameter Insect bites, urticaria, allergic reaction


Wheal. From Farrar et al, 1992.

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Mar 25, 2017 | Posted by in PHYSIOLOGY | Comments Off on Skin, Hair, and Nails

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